Thursday, January 14, 2010

Medical Malpractice

An interesting side show

Hospital executives are now the latest group to flaunt their wealth in the face of the unemployed,

Wall Street isn’t the only ones taking down big bonuses. Hospital presidents and CEOs are also collecting fat bonuses and incentive payments, even as our health-care systems cry poverty, claiming they struggle to break even against government cutbacks, tightwad insurers and skyrocketing costs.

While hospitals have been laying off personnel in nursing, and warning of further layoffs and slashed patient services, many hospitals shower their top execs and department heads with bonuses and perks. They include housing allowances, chauffeurs, first-class air travel, tuition for their children and country-club memberships.

Under new IRS rules, effective 2008, the extras are now required to be disclosed for the first time.

The filings for the city’s biggest and most prestigious private, tax-exempt hospitals show at least a dozen CEOs got compensation of $1 million and up. Some also cash in early on million-dollar pre-retirement payouts while on the job.

Dr. Herbert Pardes, who runs the New York-Presbyterian Hospital and its health-care system -- the city's largest private hospital network, received a $1 million bonus in 2008 on top of his $1.67 million salary.

The hospital has a "pay for performance" philosophy but says even though Pardes met his goals, his bonus was smaller than 2007's to "reflect the current external environment."

Pardes' compensation totaled $9.8 million in 2008 because he vested in a retirement plan that will pay $6.8 million when he leaves in 2011. He also received a $93,500 housing allowance and the use of a car and driver.

The $4.2 million 2008 compensation for Steven Safyer, CEO of Montefiore Medical Center in The Bronx, another major teaching hospital, included a $1.2 million salary, a $452,789 bonus, a $6,000 college scholarship for his child and $2.1 million in pre-retirement cash.

A $1.2 million bonus went to Miguel Fuentes Jr., CEO of the 958-bed Bronx-Lebanon Hospital. His $4.8 million package included $878,024 in salary and an $858,000 pre-retirement payout. He's also set to get $1.8 million in retirement cash next year.

Execs cleaned up even at struggling hospitals. Despite years of losses, 513-bed Lenox Hill Hospital on the Upper East Side gave CEO Gladys George an early-retirement payment of $752,469 on top of her relatively modest $522,206 salary. Her salary still dwarfs that of Alvin Aviles, who makes $291,000 as CEO of the city's $6.3 billion Health and Hospitals Corp., the nation's largest public system with 39,000 employees at 11 hospitals, four nursing homes and many treatment centers.

Perhaps this is the reason our health care system is so over priced, and so ineffective
perhaps if there were less greed, and more concern for patients mal practice litigation might be less troublesome.

A few years back Harvard researchers found that 1% of a representative sample of patients treated in New York state hospitals in 1984 were injured, and one-quarter of those died, because of medical negligence. Nationwide, that would have translated into 234,000 injuries and 80,000 deaths in 1988 from negligence in American hospitals.

Most of this involves physicians. There is no clear evidence that there has been significant improvement since then.

A similar study conducted in California in 1974 found that 0.8% of hospital patients had either been injured by negligence in the hospital or had been hospitalized because of negligent care. Extrapolation of those findings would have yielded an estimate of 249,000 injuries and deaths from negligent medical practice in 1988.

In 1976 the HEW Malpractice Commission estimated similarly that one-half of 1% of all patients entering hospitals are injured there due to negligence. That estimate would have indicated 156,000 injuries and deaths resulting from doctor negligence in 1988.

Expanding these estimates to include general medical practice outside of a hospital, the potential abuse by physicians is even greater. An in-depth interview with 53 family physicians revealed that 47% of the doctors recalled a case in which the patient died due to physician error. Only four of the total reported errors led to malpractice suits, and none of these errors resulted in an action by a peer review organization.

Medical students at SUNY-Buffalo were asked to recall incidents during their clinical training that raised ethical concerns. More than 200 students responded (40% of total sample); the majority of instances they reported (60%) did not in the researchers’ opinions threaten the patient’s life, health or welfare. This, however, implies that potentially 40% did.

It is not unreasonable to estimate that at least 1 percent of doctors in this country deserve some serious disciplinary action each year. This would amount to 7,703 physicians being disciplined each year, a number that, unfortunately far exceeds the actual number of physicians disciplined.

Two studies surveyed residents to determine the incidence of substance use. Recent alcohol use was extremely high in both groups (87% within the last year for emergency medicine residents; 74% within the past 30 days for surgery residents).Additional findings proved extremely disturbing; although the emergency medicine program directors accurately determined the incidence of alcohol use amongst residents, they dramatically underestimated the percent who were actually impaired by the substance as indicated by diagnostic tests (1% estimate impaired vs. 13% diagnosed.)

This does not bode well for creating a medical system that prevents mishaps before they occur. And although the surgery residents reported negligible recent cocaine use, when employed, the drug was typically obtained from the hospital supply, indicating a greater ease of access than for the general population.

In order that Doctors and hospital staff can continue their addictive habits. It does appear that the higher salaries are necessary. Perhaps also, if we reduce those perks, and salaries, the addictions may subside, and we may have cheaper and more affective health care, perhaps not!